Care Quality Commission
Our approach to assessing local authorities
The Health and Care Act 2022 gives us new powers that allow us to provide a meaningful and independent assessment of care at a local authority and integrated care system level. We are expecting our new powers to start this April.
They will enable us to start to understand the quality of care in a local area or system and provide independent assurance to the public of the quality of care in their area.
Below, we outline an update on what we have been doing and our ongoing approach to local authority and integrated care system assessments.
We also provide our interim guidance for our assessment of local authorities.
To design these assessments, we have been working in partnership with:
- Department of Health and Social Care (DHSC)
- people who use health and social care services and their families
- Local Government Association (LGA)
- Association of Directors of Adult Social Services (ADASS)
- integrated care systems
- local government
- NHS England
- other provider representatives and strategic partners.
We will continue working in this way with the LGA, ADASS and other partners, to ensure our assessments add value by encouraging improvement where needed and keeping people safe.
We have also used the feedback and learning from our 'test and learn activity’ on aspects of our overall assessment approach to refine the methods we will use. To focus on how useful the test and learn activities have been, we have published a podcast conversation between CQC colleagues and the local authorities involved.
Unlike the legislation underpinning our regulatory approach to providers of health and social care, the Health and Care Act 2022 states that our approach to assessing local authorities and integrated care systems is subject to the approval of the Secretary of State for Health and Social Care.
When assessing local authorities and integrated care systems, we will use our new single assessment framework. Although we’ll use this in the same way as when assessing providers, the approach will be tailored carefully to their specific context.
The single assessment framework uses quality statements. We developed these with people who use services and they are based on people’s experiences and the standards of care they expect. The quality statements show what is needed to deliver high-quality, person-centred care and are commitments that providers, commissioners and system leaders should live up to.
To assess local authorities and integrated care systems we will use a subset of the quality statements. We will provide an update and publish guidance on the specific quality statements for assessing integrated care systems soon.
You can find out more information about the quality statements for local authority assessment in the guidance published on this page. We shared a draft of these quality statements with local government and other key stakeholders last autumn, and there have been minimal changes since then.
The guidance we are publishing is currently subject to government approval as required by the Health and Care Act 2022.
Local authority assessments
We want to ensure operational colleagues are going out to visit local authorities as part of the assessment process. We are currently working on timescales for this and will provide an update in due course when we have more information available.
To make sure our assessments are as effective as possible, we expect to implement them as follows.
April to September 2023
From 1 April, we will start to review data and published documentary evidence across all local authorities. We will focus on themes in these 2 quality statements:
- Care provision, integration and continuity
- Assessing needs
We will also look at themes and insight on:
- market shaping
We will not publish this data and evidence at individual local authority level. We will instead use our independent voice to publish it at an overall national level as a collection of evidence. For example, in our annual statutory State of Care report to Parliament.
This national review will be the first element towards full assessment of these 2 quality statements. It will constitute our first steps in developing judgements for individual authorities. It will also provide valuable context and an opportunity to benchmark our data.
We also intend to start a limited number of pilot assessments from April. These will cover up to 5 local authorities between April and September 2023.
September to December 2023
Assessing local authorities is a new duty for CQC. Before we can move to ongoing assessments, we need to complete an initial formal assessment for all local authorities to establish a starting point. We will therefore start formal assessments in September, and aim to carry out up to 20 assessments between September and December. We will then work with the local authorities and others on the best way to publish our findings from these pilots.
Early 2024 onwards
We would then continue to carry out further formal assessments from early 2024 onwards and report on our findings. The Government has also asked us to publish individual ratings of local authorities following our pilots and assessments. We will work with local authorities and DHSC to inform how we publish our findings and ratings.
Our approach will enable us to build up a national picture by using our independent assessment expertise in a credible and consistent way.
Interim guidance on local authority assessment
You can now read our current interim guidance [link] for assessing local authorities:
This sets out the high-level framework for our oversight of local authorities, focusing on the initial baselining period.
The guidance focuses on:
- themes and quality statements
- evidence categories
- how we will assess local authorities
- reporting and sharing information
- intervention and escalation
We will expand and update this interim guidance in collaboration with stakeholders as we develop our model and transition to ongoing assessment. It will form the basis for the more detailed end-to-end guidance on our regulatory processes and the information in our communications and engagement activity.
Integrated care systems
We want to start to assess integrated care systems as soon as it’s practical and meaningful to do so. We’re currently working closely with and seeking approval from the DHSC on our approach to implementing these assessments and will provide more details on this as soon as possible. We are also engaging with the Hewitt Review to contribute our learning and to understand any potential considerations for our approach.
Once we have agreement from DHSC on our approach, we will be able to finalise guidance on how we will assess integrated care systems using our single assessment framework. We will publish this as soon as possible and will provide an update when it is available.
If you are working within a local authority or integrated care system and would like to get further updates from us about this work, please register your interest. We will then add you to the mailing list.
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